EDI Resource Center

X12 EDI 835

What is an EDI 835 Healthcare Claim Payment/Advice?

The EDI 835 healthcare Claim Payment and Remittance Advice is mainly used by healthcare insurance plans to make payments to healthcare providers, give Explanations of Benefits (EOBs), or both.

It can also be used to make a payment and send an EOB remittance advice only from a health insurer to a healthcare provider. This can be done either directly or by using a financial institution.

EDI 835 Benefits

  • Helps insurers accurately and rapidly keep transactions updated with healthcare providers
  • Helps ensure correct payments, not overpayments or underpayments
  • Speeds along the healthcare provision process
  • Helps healthcare providers track what payments were received for services they provided and billed

Key Data Elements You'll Find in a Healthcare Claim Payment/Advice:

  • Any splitting of claims or line items
  • What charges were paid, reduced or denied
  • Whether there was a deductible, co-insurance, co-pay, etc.
  • How the payment was made ( i.e through a clearinghouse)

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